一期双膝关节与单膝关节置换的早期评价

背景：膝关节置换一期双侧置换还是单膝分期置换一直存在着争议。目的：评价双膝关节疾病患者一期双侧全膝关节置换与选择性单侧全膝关节置换后早期临床疗效及SF-36健康问卷调查差异。方法：初次行全膝关节置换的患者144例190膝，均采用施乐辉公司假体行一期双膝全膝关节置换(双膝组)及一期选择性单膝全膝关节置换(单膝组)。观察患者膝关节置换前后活动范围 、HSS 评分及疼痛评分、置换后并发症及置换后SF-36量表调查结果。结果与结论：随访1年，9例失访，135例进入结果分析。膝关节置换后双膝组1例发生一过性腓总神经麻痹，1例获得性免疫缺陷综合征，1例发生切口愈合不良；单膝组发生2例切口愈合不良。膝关节置换后1年，SF-36 量表调查，两组除生理职能比较差异有显著性意义(P < 0.05) 外，其余7方面比较差异均无显著性意义(P > 0.05)；两组活动范围比较差异无显著性意义(P > 0.05)；两组HSS 评分比较差异无显著性意义(P > 0.05)；双膝组疼痛评分显著低于单膝组(P < 0.05)。结果证实，双膝组膝关节置换后早期在疼痛评分方面优于单膝组，但SF-36 量表评价、HSS膝关节功能评分及关节活动范围等方面较单膝组无明显优势。

Early evaluation of one-stage bilateral knee joint and unilateral knee joint replacement

BACKGROUND:There is a controversy on one-stage bilateral knee joint and unilateral knee joint replacement.OBJECTIVE:To evaluate early clinical efficacy and SF-36 health survey differences on the patients with bilateral knee disease after bilateral knee joint replacement and selective unilateral knee joint replacement.METHODS:A total of 144 patients (190 knees) were treated with bilateral knee joint replacement (bilateral group) and selective unilateral knee joint replacement (unilateral group), the prostheses were made by Smith & Nephew (GenesisTM ‖ smith & nephew). The range of motion, hospital for special surgery (HSS) score and visual analogous scale score, as well as the postoperative complications and postoperative SF-36 survey results were observed.RESULTS AND CONCLUSION:After one-year follow-up, 9 cases were lost and 135 patients entered the final analysis. In the bilateral group, there was 1 case of transient peroneal nerve palsy, 1 case of acquired immunodeficiency syndrome and 1 case of poor wound healing; in unilateral group, there were 2 cases of poor wound healing. At 1 year after replacement, SF-36 survey results showed that there was a significant difference of physiological function between two groups (P < 0.05), and there was no significant difference of the other seven factors between two groups (P > 0.05); there was no significant difference of range of motion and HSS score between two groups (P > 0.05); the visual analogous scale score in the bilateral group was lower than that in the unilateral group (P < 0.05). Results show that the early visual analogous scale score in the bilateral group is lower than that in the unilateral group, however, there is no significant difference of the SF-36 survey, HSS score and range of motion between two groups.